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Extrahepatic biliary tract obstruction: Stents v biliary diversion surgery or cholecystectomy?
White RN.
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Surgical diseases of the extrahepatic biliary tract (EHBT) in small animals are not uncommon. A review of the recent veterinary literature in a recently published small animal soft tissue surgery textbook provided a sobering insight into the overall outcome of dogs and cats undergoing surgery for diseases of the EHBT (Mehler and Mayhew 2013). When study numbers were combined, the overall survival rate for dogs was 63.6% (140 of 220) and for cats was 41% (28 of 68) (Martin and others 1986, Fahie and Martin 1995, Ludig and others 1997, Mayhew and others 2002, Bacon and White 2003, Mehler and others 2004, Pike and others 2004a, Pike and others 2004b, Worley and others 2004, Amsellem and others 2006, Buote and others 2006, Mayhew and others 2006, Mayhew and Weisse 2008, Morrison and others 2008). Extrahepatic biliary duct obstruction (EHBDO) is only one of four common reasons for performing biliary tract surgery in small animals. The remaining three reasons are gallbladder mucocoele, traumatic injury and cholelithiasis. In all cases, the main aim of surgery is to confirm the underlying disease process, establish a patent biliary system and minimize perioperative complications (Mehler and Mayhew 2013).
Causes of EHBDO are well recognized and include cholelithiasis, neoplasia, pancreatitis, inspissated bile, gallbladder mucocoeles, parasites, duodenal foreign body, malformations, fibrosis and stricture formation (Center 2009). The commonest cause of extrahepatic biliary duct obstruction (EHBDO) in dogs and cats is its secondary association with acute/chronic pancreatitis (extrinsic compression of the opening of the common bile duct into the duodenum) (Cribb and others 1988, Fahie and Martin 1995). [...]
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